- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.96 / $650.66 / $2,371.67
| Facility | | $477.96 | $650.66 | $2,371.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.55 / $536.58 / $586.17
| Professional | | $270.55 | $536.58 | $586.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.01 / $806.36 / $1,133.45
| Facility | | $472.01 | $806.36 | $1,133.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.91 / $450.91 / $450.91
| Facility | | $450.91 | $450.91 | $450.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.84 / $864.85 / $3,185.57
| Facility | | $471.84 | $864.85 | $3,185.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.38 / $225.46 / $563.64
| Professional | | $189.38 | $225.46 | $563.64 |